Today, I went out on my first referral.
Met a sweet patient today, year 3 of fighting lung cancer; she is now stage III-IV.
Hubby at bedside. She verbalized she just wished someone would put "something" in her IV so she could just say "goodbye cruel world". Hubby at bedside wants someone with her at home all the time while he is at work. He is afraid to leave her alone at this point, said "i came home the other day and an ambulance is at the house....I don't want that to happen again." Sweet patient
says "I don't want to go back to that house...we've been there 3 yrs and it only holds bad memories....I just want to go somewhere where i'm not a burden." She said she didn't want any equipment (although on 02 in the hospital)...
Anywhoo, as patient is barely to care for self ADL's, I said that home health aides can be in her home 5 days/week to help her bathe...with once a week scheduled nursing visits...hubby chimed in that he wants someone there 12-14 hours a day.....
She was getting stressed out, so we agreed that we would talk again on Monday afternoon, and I encouraged her that we would help her find the best plan to help her.
I spoke to my mentor who is just a darling, who said we can do our part with the hospice portion, and help them find assisted living/nursing home placement, etc.
How could I have handled this differently? The last admission I went on with my mentor, little frail end stage dementia patient with 4 generations of family in the home, sooooo supportive of patient, eager for home hospice. Maybe I just expected the same smooth sailing.
Thank you for your input. Perhaps it would have been a good thing for my mentor to come with me and learn how she would handle this situation, but i've got to learn sometime!!! I did hospice 10 yrs ago, and it seemed like a cookie cutter plan...either you fit or your didn't. I feel like I could have done a better job.
Dec 16, '06
Be patient with yourself. I'm not a hospice nurse but know that starting a new job is difficult and you second guess yourself. I think you did just fine. You stopped when you realized that hubby was asking for more than you could give and went and asked what else could be done. I think you did just fine.
Dec 17, '06
AtlantaRN, you did well, you explained what Hospice could do in the home, you backed away to allow the patient and husband to discuss, you spoke
to your mentor about options, and you plan to followup on Monday with
your encouragement that you will do whatever is best for the patient.
Dec 17, '06
thank you, you both are kind. it's been 10 yrs and I guess it's normal to feel like a fish out of water....
Dec 18, '06
One other thought. Utilize your interdisciplinary team so you won't stress yourself out going solo. The social worker should be able to sit down and discuss goals and expectations and spend time looking for community resources (i.e., eligibility for respite services, private duty nursing, etc)
Dec 18, '06
Atlanta RN, you did what you can do.... which is to tell them what Hospice can offer them now, at this stage of her disease. I know that her hubby wants
someone to stay with her many hours a day. He can certainly get that if he wants to hire private duty nursing...but it is very expensive and not many people can afford to have it.
It would be wonderful if Hospice could offer them them everything they want (or need) but that isn't the reality of our health care system today. You can only tell them what Hospice can provide, what community resources there are (nursing home, day care, etc) and what services they can purchase (paid companion, nursing etc). I assume they have already recruited all available family members for assistance? I agree with the poster who encouraged you to get other interdisciplinary team members involved (assuming they sign on for hospice) because a social worker could be useful to them.
As someone with many years of hospice (and other nursing) experiences I can sympathize with you as to how torn you are when your patients or their families want something that you can't provide. It would be lovely if we lived in a world where everyone's health care needs were provided for....but we don't. Do the best you can and know that is all you can do anyway! Good luck!
Dec 23, '06
fianally got patient admitted on the 21st.
husband signed most critical paperwork. patient refused assessment at that time. She did let me take her vitals on the 22nd, and she verbalized irritation because i didn't have a pulse oximeter....she said "i think that would be the most important thing!" educated that we can use objective and subjective assessment--no use of accessory muscles, capillary refill, etc. ( i have a pulse oximeter at home, hubby had a pe 6 yrs ago and i bought one)...Education with her is the key.
i told her my job was to help keep her out of the hospital.
she was in better spirits.
Dec 23, '06
lots of folks think we (hospice nurses) come to stay 24 hrs/day instead of intermittently. (especially when we show up on the visit w/ the huge 'nursing bag') Did you read Tuesdays w/ Morrie? At the end, the author noted a 'hospice nurse' posted outside the room. I wrote him and told him that he did hospices a great disservice. Anyway, there is continuous care, usually provided by private duty agency, for health crisis and respite care for caretaker crisis. make it clear that hospice is INTERMITTENT care or you will be overwhelmed and burnt out VERY quickly.
-personal care home
-more RN hospice vss /week (1/week is too little, esp at first)
-Agency on Aging referral. they provide respite care in some states
-volunteers. they are required under medicare cost savings anyway.
-get 02 in on first visit, but no routine pulse ox. explain that hospice goal is too make pt comfortable, not to keep #'s in line. This applies to labs, wts, measuring ankle and abd circumference, I&O's etc. Thinking this through, you realize the pulse ox will drop, wt will drop, ankles will swell etc and this is normal during the last few days of life. If you are monitoring these, the families get VERY anxious.
-use the interdiscipliary team.
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